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Nelson HS, Sowers T, Plunkett G, Nolte H, Rance K. The Art of Dosing for Subcutaneous Immunotherapy in North America. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:13-22. [PMID: 37385447 DOI: 10.1016/j.jaip.2023.06.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 05/18/2023] [Accepted: 06/13/2023] [Indexed: 07/01/2023]
Abstract
Subcutaneous immunotherapy (SCIT) is a long-established treatment option for allergic rhinoconjunctivitis. Proper dosing of the allergens is critical for the efficacy and safety of SCIT. Of the hundreds of liquid allergen extracts in the United States, effective and well-tolerated SCIT dosing has only been established for a small number. Thus, SCIT dosing remains largely empiric and continues to be, by necessity, an art. To highlight the complexity of SCIT dosing, this review summarizes the historical and current landscape of U.S. allergen extracts, differences among U.S. and European allergen extracts, allergen selection for SCIT, considerations for compounding of allergen extract mixtures, and recommended dosing. As of 2021, 18 standardized allergen extracts are available in the United States; all other extracts remain unstandardized without characterization of allergen content or potency. U.S. allergen extracts differ from European extracts in formulation and potency characterization. There is no standardized methodology for SCIT allergen selection, and interpretation of allergen sensitization is not straightforward. Compounding of SCIT mixtures requires consideration of potential dilution effects, allergen cross-reactivity, proteolytic activity, and additives. Probable effective dose ranges for SCIT are recommended in U.S. allergy immunotherapy practice parameters, although there are few studies using U.S. extracts supporting these doses as therapeutic. In contrast, optimized doses of sublingual immunotherapy tablets have been confirmed in North American phase 3 trials. The SCIT dosing for each patient remains an art that requires clinical experience and consideration of polysensitization, tolerability, compounding of allergen extract mixtures, and the range of recommended doses within the context of extract potency variability.
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Affiliation(s)
- Harold S Nelson
- Department of Medicine, National Jewish Health, Denver, Colo
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Jõgi NO, Kitaba N, Storaas T, Schlünssen V, Triebner K, Holloway JW, Horsnell WGC, Svanes C, Bertelsen RJ. Ascaris exposure and its association with lung function, asthma, and DNA methylation in Northern Europe. J Allergy Clin Immunol 2021; 149:1960-1969. [PMID: 34996616 DOI: 10.1016/j.jaci.2021.11.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 10/29/2021] [Accepted: 11/05/2021] [Indexed: 01/17/2023]
Abstract
BACKGROUND Ascaris infections, with a worldwide prevalence above 10%, can cause respiratory pathology. However, long-term effects on lung function in humans are largely unknown. OBJECTIVE We investigated the associations of Ascaris exposure with lung function, asthma, and DNA methylation. METHODS Serum Ascaris IgG antibodies were measured in 671 adults aged 18 to 47 years (46% women) from Aarhus, Bergen, and Tartu RHINESSA study centers. Seropositivity was defined as IgG above the 90th percentile. Linear and logistic regressions were used to analyze Ascaris seropositivity as associated with lung function and asthma, adjusted for age, height, and smoking and clustered by center. DNA methylation in blood was profiled by a commercial methylation assay. RESULTS Ascaris seropositivity was associated with lower FEV1 (-247 mL; 95% CI, -460, -34) and higher odds for asthma (adjusted odds ratio, 5.84; 95% CI, 1.67, 20.37) among men but not women, also after further adjusting for house dust mite sensitivity, consistent across study centers. At a genome-wide level, Ascaris exposure was associated with 23 differentially methylated sites in men and 3 in women. We identified hypermethylation of the MYBPC1 gene, which can regulate airway muscle contraction. We also identified genes linked to asthma pathogenesis such as CRHR1 and GRK1, as well as a differentially methylated region in the PRSS22 gene linked to nematode infection. CONCLUSION Ascaris exposure was associated with substantially lower lung function and increased asthma risk among men. Seropositive participants had sex-specific differences in DNA methylation compared to the unexposed, thus suggesting that exposure may lead to sex-specific epigenetic changes associated with lung pathology.
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Affiliation(s)
- Nils O Jõgi
- Department of Clinical Science, University of Bergen, Bergen, Norway; Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway.
| | - Negusse Kitaba
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Torgeir Storaas
- Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway
| | - Vivi Schlünssen
- Department of Public Health, Environmental Occupation, and Health, Danish Ramazzini Centre, Aarhus University, Aarhus, Denmark; National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Kai Triebner
- Department of Clinical Science, University of Bergen, Bergen, Norway; Core Facility for Metabolomics, University of Bergen, Bergen, Norway
| | - John W Holloway
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - William G C Horsnell
- Institute of Infectious Disease and Molecular Medicine/Division of Immunology, University of Cape Town, Cape Town, South Africa; Institute of Microbiology and Infection, University of Birmingham, Birmingham, United Kingdom; Laboratory of Molecular and Experimental Immunology and Neurogenetics, CNRS-University of Orléans and Le Studium Institute for Advanced Studies, Orléans, France.
| | - Cecilie Svanes
- Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway; Centre for International Health, University of Bergen, Bergen, Norway
| | - Randi J Bertelsen
- Department of Clinical Science, University of Bergen, Bergen, Norway; Oral Health Centre of Expertise in Western Norway, Bergen, Norway
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Laursen KR, Rasmussen BB, Rosati B, Gutzke VH, Østergaard K, Ravn P, Kjaergaard SK, Bilde M, Glasius M, Sigsgaard T. Acute health effects from exposure to indoor ultrafine particles-A randomized controlled crossover study among young mild asthmatics. INDOOR AIR 2021; 31:1993-2007. [PMID: 34235780 DOI: 10.1111/ina.12902] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 06/09/2021] [Accepted: 06/23/2021] [Indexed: 06/13/2023]
Abstract
Particulate matter is linked to adverse health effects, however, little is known about health effects of particles emitted from typical indoor sources. We examined acute health effects of short-term exposure to emissions from cooking and candles among asthmatics. In a randomized controlled double-blinded crossover study, 36 young non-smoking asthmatics attended three exposure sessions lasting 5 h: (a) air mixed with emissions from cooking (fine particle mass concentration): (PM2.5 : 96.1 μg/m3 ), (b) air mixed with emissions from candles (PM2.5 : 89.8 μg/m3 ), and c) clean filtered air (PM2.5 : 5.8 μg/m3 ). Health effects (spirometry, fractional exhaled Nitric Oxide [FeNO], nasal volume and self-reported symptoms) were evaluated before exposure start, then 5 and 24 h after. During exposures volatile organic compounds (VOCs), particle size distributions, number concentrations and optical properties were measured. Generally, no statistically significant changes were observed in spirometry, FeNO, or nasal volume comparing cooking and candle exposures to clean air. In males, nasal volume and FeNO decreased after exposure to cooking and candles, respectively. Participants reported additional and more pronounced symptoms during exposure to cooking and candles compared to clean air. The results indicate that emissions from cooking and candles exert mild inflammation in asthmatic males and decrease comfort among asthmatic males and females.
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Affiliation(s)
| | | | - Bernadette Rosati
- Department of Chemistry, Aarhus University, Aarhus, Denmark
- Faculty of Physics, University of Vienna, Vienna, Austria
| | - Vibeke Heitmann Gutzke
- Environment, Work and Health, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Kirsten Østergaard
- Environment, Work and Health, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Peter Ravn
- Environment, Work and Health, Department of Public Health, Aarhus University, Aarhus, Denmark
| | | | - Merete Bilde
- Department of Chemistry, Aarhus University, Aarhus, Denmark
| | | | - Torben Sigsgaard
- Environment, Work and Health, Department of Public Health, Aarhus University, Aarhus, Denmark
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4
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Wintersand A, Asplund K, Binnmyr J, Holmgren E, Nilsson OB, Gafvelin G, Grönlund H. Allergens in dog extracts: Implication for diagnosis and treatment. Allergy 2019; 74:1472-1479. [PMID: 30888707 DOI: 10.1111/all.13785] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 01/11/2019] [Accepted: 01/30/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Five to ten percent of the population in affluent countries are allergic to dog. Diagnosis and treatment is based on allergen extracts from natural sources where composition and concentration are poorly defined. OBJECTIVE We aimed to quantify six dog allergens (Can f 1-6) in commercial skin prick test (SPT) solutions and to determine individual allergen profiles in dogs. METHOD The allergen content of SPT solutions from five vendors and allergen source material from three anatomical sites were analyzed. Fur and saliva samples were collected from a mixed population of 120 dogs. Can f 1-6 were quantified by inhibition ELISA using purified recombinant or natural allergens and polyclonal or monoclonal antibodies. Allergenicity was analyzed by basophil activation test. RESULTS Extensive variation in allergen composition was observed in commercial SPT vials resulting in a patient-dependent ability to activate basophils. Extract heterogeneity depended on collection site and allergen composition in individual dogs and source materials. Can f 2 and Can f 6 exhibited low levels in fur and SPT solutions, whereas Can f 4, which was the dominating allergen in fur samples, did not display similar high proportions in SPT solutions. Can f 3 varied most among SPT solutions. CONCLUSION There is a great variation of dog allergens in natural extracts raising questions of source, sampling, processing and ultimately of standardization and minimum allergen levels for accurate diagnosis and treatment.
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Affiliation(s)
- Anna Wintersand
- Department of Clinical Neuroscience, Therapeutic Immune Design Unit Karolinska Institutet Stockholm Sweden
| | - Klara Asplund
- Department of Clinical Neuroscience, Therapeutic Immune Design Unit Karolinska Institutet Stockholm Sweden
| | - Jonas Binnmyr
- Department of Clinical Neuroscience, Therapeutic Immune Design Unit Karolinska Institutet Stockholm Sweden
| | - Erik Holmgren
- Department of Clinical Neuroscience, Therapeutic Immune Design Unit Karolinska Institutet Stockholm Sweden
| | - Ola B. Nilsson
- Department of Clinical Neuroscience, Therapeutic Immune Design Unit Karolinska Institutet Stockholm Sweden
| | - Guro Gafvelin
- Department of Clinical Neuroscience, Therapeutic Immune Design Unit Karolinska Institutet Stockholm Sweden
| | - Hans Grönlund
- Department of Clinical Neuroscience, Therapeutic Immune Design Unit Karolinska Institutet Stockholm Sweden
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Ariaee N, Varasteh A, Jabbari Azad F, Sankian M. Preparation allergenic pollen extracts; the points should be considered to make high-quality products. J Immunoassay Immunochem 2018; 40:26-39. [PMID: 30422060 DOI: 10.1080/15321819.2018.1543705] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Atopic diseases have an increasing trend worldwide during the last two decades. Determining the main cause of allergic diseases, allergens, is the first step in managing and improving the issue, usually is done by Skin Prick tests (SPTs). Having allergenic extract in high quality is desired to perform a reliable SPT. Several parameters of extracts are considered including composition, stability, potency, preservation conditions, and unit definition. In this review, these factors have been explained pointing to factors might have profitable points or harmful drawback in the quality of allergen extracts.
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Affiliation(s)
- Nazila Ariaee
- a Allergy Research Center , Mashhad University of Medical Sciences , Mashhad , Iran
| | - Abdolreza Varasteh
- a Allergy Research Center , Mashhad University of Medical Sciences , Mashhad , Iran
| | | | - Mojtaba Sankian
- b Immunology Research Center , Mashhad University of Medical Sciences , Mashhad , Iran
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Wise SK, Lin SY, Toskala E, Orlandi RR, Akdis CA, Alt JA, Azar A, Baroody FM, Bachert C, Canonica GW, Chacko T, Cingi C, Ciprandi G, Corey J, Cox LS, Creticos PS, Custovic A, Damask C, DeConde A, DelGaudio JM, Ebert CS, Eloy JA, Flanagan CE, Fokkens WJ, Franzese C, Gosepath J, Halderman A, Hamilton RG, Hoffman HJ, Hohlfeld JM, Houser SM, Hwang PH, Incorvaia C, Jarvis D, Khalid AN, Kilpeläinen M, Kingdom TT, Krouse H, Larenas-Linnemann D, Laury AM, Lee SE, Levy JM, Luong AU, Marple BF, McCoul ED, McMains KC, Melén E, Mims JW, Moscato G, Mullol J, Nelson HS, Patadia M, Pawankar R, Pfaar O, Platt MP, Reisacher W, Rondón C, Rudmik L, Ryan M, Sastre J, Schlosser RJ, Settipane RA, Sharma HP, Sheikh A, Smith TL, Tantilipikorn P, Tversky JR, Veling MC, Wang DY, Westman M, Wickman M, Zacharek M. International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis. Int Forum Allergy Rhinol 2018; 8:108-352. [PMID: 29438602 PMCID: PMC7286723 DOI: 10.1002/alr.22073] [Citation(s) in RCA: 218] [Impact Index Per Article: 36.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 12/01/2017] [Accepted: 12/01/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Critical examination of the quality and validity of available allergic rhinitis (AR) literature is necessary to improve understanding and to appropriately translate this knowledge to clinical care of the AR patient. To evaluate the existing AR literature, international multidisciplinary experts with an interest in AR have produced the International Consensus statement on Allergy and Rhinology: Allergic Rhinitis (ICAR:AR). METHODS Using previously described methodology, specific topics were developed relating to AR. Each topic was assigned a literature review, evidence-based review (EBR), or evidence-based review with recommendations (EBRR) format as dictated by available evidence and purpose within the ICAR:AR document. Following iterative reviews of each topic, the ICAR:AR document was synthesized and reviewed by all authors for consensus. RESULTS The ICAR:AR document addresses over 100 individual topics related to AR, including diagnosis, pathophysiology, epidemiology, disease burden, risk factors for the development of AR, allergy testing modalities, treatment, and other conditions/comorbidities associated with AR. CONCLUSION This critical review of the AR literature has identified several strengths; providers can be confident that treatment decisions are supported by rigorous studies. However, there are also substantial gaps in the AR literature. These knowledge gaps should be viewed as opportunities for improvement, as often the things that we teach and the medicine that we practice are not based on the best quality evidence. This document aims to highlight the strengths and weaknesses of the AR literature to identify areas for future AR research and improved understanding.
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Affiliation(s)
| | | | | | | | - Cezmi A. Akdis
- Allergy/Asthma, Swiss Institute of Allergy and Asthma Research, Switzerland
| | | | - Antoine Azar
- Allergy/Immunology, Johns Hopkins University, USA
| | | | | | | | | | - Cemal Cingi
- Otolaryngology, Eskisehir Osmangazi University, Turkey
| | | | | | | | | | | | | | - Adam DeConde
- Otolaryngology, University of California San Diego, USA
| | | | | | | | | | | | | | - Jan Gosepath
- Otorhinolaryngology, Helios Kliniken Wiesbaden, Germany
| | | | | | | | - Jens M. Hohlfeld
- Respiratory Medicine, Hannover Medical School, Airway Research Fraunhofer Institute for Toxicology and Experimental Medicine, German Center for Lung Research, Germany
| | | | | | | | | | | | | | | | | | | | | | | | | | - Amber U. Luong
- Otolaryngology, McGovern Medical School at the University of Texas Health Science Center Houston, USA
| | | | | | | | - Erik Melén
- Pediatric Allergy, Karolinska Institutet, Sweden
| | | | | | - Joaquim Mullol
- Otolaryngology, Universitat de Barcelona, Hospital Clinic, IDIBAPS, Spain
| | | | | | | | - Oliver Pfaar
- Rhinology/Allergy, Medical Faculty Mannheim, Heidelberg University, Center for Rhinology and Allergology, Wiesbaden, Germany
| | | | | | - Carmen Rondón
- Allergy, Regional University Hospital of Málaga, Spain
| | - Luke Rudmik
- Otolaryngology, University of Calgary, Canada
| | - Matthew Ryan
- Otolaryngology, University of Texas Southwestern, USA
| | - Joaquin Sastre
- Allergology, Hospital Universitario Fundacion Jiminez Diaz, Spain
| | | | | | - Hemant P. Sharma
- Allergy/Immunology, Children's National Health System, George Washington University School of Medicine, USA
| | | | | | | | | | | | - De Yun Wang
- Otolaryngology, National University of Singapore, Singapore
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Spierenburg EAJ, Smit LAM, Krop EJM, Heederik D, Hylkema MN, Wouters IM. Occupational endotoxin exposure in association with atopic sensitization and respiratory health in adults: Results of a 5-year follow-up. PLoS One 2017; 12:e0189097. [PMID: 29211772 PMCID: PMC5718503 DOI: 10.1371/journal.pone.0189097] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Accepted: 11/18/2017] [Indexed: 11/18/2022] Open
Abstract
The objective of the present longitudinal study was to investigate the effects of occupational endotoxin exposure on respiratory health and atopic sensitization in adults. Health outcomes and personal endotoxin exposure estimates were determined for 234 farmers and agricultural workers both at baseline and 5 years later. A questionnaire was used to assess respiratory symptoms, spirometry tests were performed and total and specific IgE levels were measured in serum. A twofold increase in personal endotoxin exposure was associated with less hay fever (OR 0.68, 95%CI 0.54-0.87) and grass IgE positivity (OR 0.81, 95%CI 0.68-0.97) at both time points ("persistent" versus "never"). Although not statistically significant, a consistent protective pattern was observed for an increased loss of hay fever symptoms (OR 2.19, 95%CI 0.96-4.99) and grass IgE positivity (OR 1.24, 95%CI 0.76-2.02), and for less new-onset of hay fever (OR 0.87, 95%CI 0.65-1.17), grass IgE positivity (OR 0.83, 95%CI 0.61-1.12) and atopic sensitization (OR 0.75, 95%CI 0.55-1.02). Endotoxin exposure was not associated with changes in lung function. We showed that occupational endotoxin exposure is associated with a long-term protective effect on hay fever and grass IgE positivity. Results on longitudinal changes in hay fever, atopy and grass IgE positivity in adulthood were consistent with a protective effect of endotoxin exposure, but results need to be confirmed in larger cohorts. An effect of endotoxin exposure on lung function decline was not found.
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Affiliation(s)
- Elisabeth A. J. Spierenburg
- Institute for Risk Assessment Sciences, Division of Environmental Epidemiology, Utrecht University, Utrecht, the Netherlands
| | - Lidwien A. M. Smit
- Institute for Risk Assessment Sciences, Division of Environmental Epidemiology, Utrecht University, Utrecht, the Netherlands
| | - Esmeralda J. M. Krop
- Institute for Risk Assessment Sciences, Division of Environmental Epidemiology, Utrecht University, Utrecht, the Netherlands
| | - Dick Heederik
- Institute for Risk Assessment Sciences, Division of Environmental Epidemiology, Utrecht University, Utrecht, the Netherlands
| | - Machteld N. Hylkema
- Department of Pathology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- GRIAC- Groningen Research Institute for Asthma and COPD, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Inge M. Wouters
- Institute for Risk Assessment Sciences, Division of Environmental Epidemiology, Utrecht University, Utrecht, the Netherlands
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Casset A, Khayath N, de Blay F. How In Vitro Assays Contribute to Allergy Diagnosis. Curr Allergy Asthma Rep 2017; 16:82. [PMID: 27864812 DOI: 10.1007/s11882-016-0659-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Diagnosis of allergic disorders is based upon the clinical history of the disease, the immunoglobulin E (IgE) antibody response, and the allergen exposure. During the last decade, many changes have occurred in the in vitro diagnostic tests used in daily practice. The most important one is the use of allergenic molecules, which helps to define severe profile of allergy and/or to better understand cross-reactivity. The correlation between IgE sensitization and bronchial or nasal response in provocation tests is not so clear, which implies that such tests are still helpful in allergy diagnosis. In order to strengthen the link between a real allergen exposure and allergic symptoms, environmental allergen load assessment can be performed. For clinicians, it appears obvious to know the pollen count to treat their patients; however, they rarely measure the allergen load in the indoor environment, while nowadays home-tests (semi-quantitative or quantitative) make the assessment very easy. In the future, assessment of the environmental exposure (preferably with an indoor technician) of an allergic patient should take into account not only the allergens but also the other indoor pollutants, which could enhance respiratory symptoms in allergic patients.
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Affiliation(s)
- Anne Casset
- Faculty of Pharmacy, Laboratory of Conception and Application of Bioactive Molecules, CNRS, University of Strasbourg, BP 60024, 67401, Illkirch Cedex, France
| | - Naji Khayath
- Chest Diseases Department, Strasbourg University Hospital; Federation of Translational Medicine, University of Strasbourg, BP 426, 67091, Strasbourg, France
| | - Frédéric de Blay
- Chest Diseases Department, Strasbourg University Hospital; Federation of Translational Medicine, University of Strasbourg, BP 426, 67091, Strasbourg, France.
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Rönmark E, Warm K, Bjerg A, Backman H, Hedman L, Lundbäck B. High incidence and persistence of airborne allergen sensitization up to age 19 years. Allergy 2017; 72:723-730. [PMID: 27659134 DOI: 10.1111/all.13053] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Longitudinal population-based studies about the natural history of allergic sensitization are rare. The aim was to study incidence and persistence of airborne allergen sensitization up to young adulthood and risk factors for early and late onset of sensitization. METHODS All children aged 7-8 years in two municipalities in Northern Sweden were invited to a parental questionnaire and skin prick tests (SPTs) to ten airborne allergens, and 2148 (88%) participated. The protocol was repeated at age 11-12 and 19 years, and 1516 participated in all three examinations. RESULTS Prevalence of any positive SPT increased from 20.6% at age 7-8 years to 30.6% at 11-12 years, and 42.1% at 19 years. Animals were the primary sensitizers at age 7-8 years, 16.3%, followed by pollen, 12.4%. Mite and mold sensitization was low. Mean annual incidence of any positive SPT varied between 2.8 and 3.4/100 per year, decreased by age for animal, and was stable for pollen. Sensitization before age 7-8 years was independently associated with family history of allergy, OR 2.1 (95% CI 1.6-2.8), urban living, OR 1.9 (95% CI 1.2-2.9), and male sex, OR 1.3 (95% CI 1.0-1.7), and negatively associated with birth order, OR 0.8 (95% CI 0.7-1.0), and furry animals at home, OR 0.7 (95% CI 0.7-0.9). Incidence after age 11-12 years was associated only with family history of allergy. Multisensitization at age 19 years was significantly associated with early age at sensitization. Remission of sensitization was uncommon. CONCLUSION The increasing prevalence of allergic sensitization by age was explained by high incidence and persistence. After age 11-12 years, the factors urban living, number of siblings, and male sex lost their importance.
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Affiliation(s)
- E. Rönmark
- Department of Public Health and Clinical Medicine; Division of Occupational and Environmental Medicine; The OLIN Unit; Umeå University; Umeå Sweden
| | - K. Warm
- Department of Public Health and Clinical Medicine; Division of Occupational and Environmental Medicine; The OLIN Unit; Umeå University; Umeå Sweden
- Division of Medicine; The OLIN Unit; Umeå University; Umeå Sweden
| | - A. Bjerg
- Department of Women's and Children's Health; Karolinska Institutet; Stockholm Sweden
| | - H. Backman
- Department of Public Health and Clinical Medicine; Division of Occupational and Environmental Medicine; The OLIN Unit; Umeå University; Umeå Sweden
| | - L. Hedman
- Department of Public Health and Clinical Medicine; Division of Occupational and Environmental Medicine; The OLIN Unit; Umeå University; Umeå Sweden
- Department of Health Sciences; Division of Nursing; Luleå University of Technology; Luleå Sweden
| | - B. Lundbäck
- Krefting Research Centre; Institute of Medicine; University of Gothenburg; Gothenburg Sweden
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Bunne J, Moberg H, Hedman L, Andersson M, Bjerg A, Lundbäck B, Rönmark E. Increase in Allergic Sensitization in Schoolchildren: Two Cohorts Compared 10 Years Apart. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2016; 5:457-463.e1. [PMID: 27838328 DOI: 10.1016/j.jaip.2016.09.025] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 09/01/2016] [Accepted: 09/16/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Time trends of incidence of allergic sensitization are unknown and recent trends of prevalence and risk factors are lacking. OBJECTIVE To estimate the incidence, prevalence, remission, risk factors, and time trends for allergic sensitization among schoolchildren followed from age 7 to 8 years to age 11 to 12 years. METHODS In 2006, all children in grades 1 and 2 aged 7 to 8 years in 2 municipalities in northern Sweden were invited to a questionnaire survey and to skin prick testing to 10 common airborne allergens. The cohort was reexamined in 2010, with additional blood sampling for specific IgE. Participation rates were 90% (n = 1700) at age 7 to 8 years and 85% (n = 1657) at age 11 to 12 years. The results were compared with a cohort examined by identical methods 10 years earlier. RESULTS The prevalence of positive skin prick test result to any allergen increased from 30% at age 7 to 8 years to 41% at age 11 to 12 years (P < .001). The cumulative 4-year incidence was 18%, while remission was low. Sensitization to pollen and furred animals was most common. A family history of allergy was significantly associated with incident sensitization, whereas the presence of furred animals at home was negatively associated. The prevalence at age 7 to 8 years and at age 11 to 12 years and the 4-year incidence were all significantly higher compared with the cohort examined 10 years earlier. CONCLUSIONS The prevalence of allergic sensitization increased by age as a consequence of a high incidence and a low remission. The trends of increasing incidence and prevalence among schoolchildren imply future increases in the prevalence of allergic diseases.
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Affiliation(s)
- Joakim Bunne
- Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine, the OLIN Unit, Umeå University, Umeå, Sweden
| | - Helena Moberg
- Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine, the OLIN Unit, Umeå University, Umeå, Sweden
| | - Linnea Hedman
- Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine, the OLIN Unit, Umeå University, Umeå, Sweden; Department of Health Sciences, Division of Nursing, Luleå University of Technology, Luleå, Sweden
| | - Martin Andersson
- Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine, the OLIN Unit, Umeå University, Umeå, Sweden
| | - Anders Bjerg
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Bo Lundbäck
- Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Eva Rönmark
- Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine, the OLIN Unit, Umeå University, Umeå, Sweden.
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